Orange County NC Website
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DocuSign Envelope ID:7883307E-C860-4560-99B8-EE98E3EB6B35 <br /> Like us an <br /> Facebook <br /> CUSTOMER ACCOUNT TERMS & CONDITIONS <br /> Date of Application: 6126/2018 HOW 111D YOU HEAR ASOUT US? Sales CaII LF Employee Initials DNR <br /> WORK SITE INFORMATION <br /> Is this a Federal, State or D.O.T.job?If Yes.what is minimum wage?$ Prevailing wage list available to us? <br /> Orange County Dept.of Asset Management Services <br /> Legal Company: Date Business Established <br /> Billing Address: City: State: <br /> PO Box 187 Hillsborough 200 S.Cat Zip: 27278 <br /> Physical Address: <br /> 200 S.Cameron St City: Hillsborough State: NC Zip: 27278 <br /> Phone: Fax: Federal ID# Email Address: adorman @orangeccuntync.gov <br /> IF NOT INCORPORATED please provide your PERSONAL CREDIT INFORMATION <br /> Owner's Name: Social Security#: Date of Birth: <br /> Driver's License State&Number: Home Phone: <br /> ome Address: City: State: Zip: <br /> BUSINESS TRADE REFERENCES <br /> Bank Name: SunTrust Contact Name: NIA Phone 919-296-6003 <br /> 200+ Yes <br /> Account Number: Doing Business How long? Goad Standing? <br /> l)Trade Reference Name: Dual Supply Contact Name: Phone 919-732-2442 <br /> Year's Business Relationship has existed? Pays within agreed upon terms?Y or N Highest Credit Balance:$ <br /> News of Orange 919-732-2171 <br /> 2)Trade Reference Name: Contact?dame: Phone <br /> Year's Business Relationship has existed? Pays within agreed upon terms?Y or N Highest Credit Balance:S <br /> Braxton Tire 919-732-1155 <br /> 3)Trade Reference Name: Contact Name Phone <br /> Year's Business Relationship has existed? Pays within agreed upon terms?Y or N Highest Credit Balance:$ <br /> Fax to: (919)713-0719 or Email to: Raleigh @laborfinders.com Requested By: DNR <br /> Customer Credit Limit:$ Date: <br /> 1 Please Read And Complete All Pages And Return To Us For Processing Form CAT April 2018 <br />